目的 探讨加速康复外科(ERAS)联合腹腔镜胆总管探查术(LCBDE)在胆总管结石患者治疗中的临床疗效.方法 选取2011年1月至2013年12月皖南医学院附属弋矶山医院收治的84例胆总管结石患者进行前瞻性研究.采用随机、单盲对照法,通过随机数字表法将入组患者分为对照组和加速康复组.两组均行LCBDE,对照组患者围术期采用传统处理方案;加速康复组患者围术期采用ERAS处理方案.采用门诊随访,了解患者术后临床表现、肝功能和是否有结石残留,随访时间截至术后6个月.比较两组患者手术时间、术中出血量、术后并发症、肠功能恢复时间、住院时间、住院总费用和随访情况等指标.正态分布的计量资料以x±s表示,两两比较采用独立样本t检验,计数资料比较采用x2检验.结果 筛选出符合研究条件的患者75例,对照组35例,加速康复组40例.两组患者手术均顺利完成.对照组和加速康复组患者手术时间和术中出血量分别为(185±46) min、(124±28) mL和(178±37) min、(114±32) mL,两组比较,差异无统计学意义(t=0.729,1.431,P＞0.05).对照组患者分别有12、14、10例发生术后切口疼痛、呕吐和各类感染,加速康复组分别有5、6、4例,两组比较,差异有统计学意义(x2=5.054,5.966,4.241,P ＜0.05).对照组和加速康复组患者术后第1天WBC、ALT、DBil分别为(11.4±3.5)×109/L、(128±33) U/L、(38 ± 14) μmol/L和(10.6±3.0)×109/L、(135±35) U/L、(44±16) μmol/L,第4天分别为(7.8±2.9)×109/L、(48±14) U/L、(21 ±8) μmol/L和(6.9±2.1)×109/L、(43±13) U/L、(20±7)μmol/L,两组比较,差异无统计学意义(t=1.018,-0.872,-1.767,1.553,1.836,1.044,P＞0.05).对照组和加速康复组患者肛门排气时间、开始进食时间、术后输液时间、住院时间分别为(42±13)h、(45±14)h、(6.8±2.3)d、(11.3 ±4.5)d和(35±11)h、(19 ±7)h、(4.2±1.8)d、(9.6 ±2.4)d,两组比较,差异有统计学意义(t=2.741,10.524,5.485,2.077,P＜0.05).对照组和加速康复组患者住院总费用分别为(18 729±3 127)元和(16 981 ±2 756)元,两组比较,差异有统计学意义(t=2.574,P＜0.05).术后1个月,所有患者肝功能恢复正常,T管胆道造影检查发现两组患者各有4例结石残留,经胆道镜取石痊愈;至随访结束,所有患者未再次出现腹痛、黄疸和发热等胆道并发症.结论 ERAS联合LCBDE治疗胆总管结石安全,具有并发症发生率低、术后恢复快、住院时间短、总费用少等优点.
目的 探討加速康複外科(ERAS)聯閤腹腔鏡膽總管探查術(LCBDE)在膽總管結石患者治療中的臨床療效.方法 選取2011年1月至2013年12月皖南醫學院附屬弋磯山醫院收治的84例膽總管結石患者進行前瞻性研究.採用隨機、單盲對照法,通過隨機數字錶法將入組患者分為對照組和加速康複組.兩組均行LCBDE,對照組患者圍術期採用傳統處理方案;加速康複組患者圍術期採用ERAS處理方案.採用門診隨訪,瞭解患者術後臨床錶現、肝功能和是否有結石殘留,隨訪時間截至術後6箇月.比較兩組患者手術時間、術中齣血量、術後併髮癥、腸功能恢複時間、住院時間、住院總費用和隨訪情況等指標.正態分佈的計量資料以x±s錶示,兩兩比較採用獨立樣本t檢驗,計數資料比較採用x2檢驗.結果 篩選齣符閤研究條件的患者75例,對照組35例,加速康複組40例.兩組患者手術均順利完成.對照組和加速康複組患者手術時間和術中齣血量分彆為(185±46) min、(124±28) mL和(178±37) min、(114±32) mL,兩組比較,差異無統計學意義(t=0.729,1.431,P＞0.05).對照組患者分彆有12、14、10例髮生術後切口疼痛、嘔吐和各類感染,加速康複組分彆有5、6、4例,兩組比較,差異有統計學意義(x2=5.054,5.966,4.241,P ＜0.05).對照組和加速康複組患者術後第1天WBC、ALT、DBil分彆為(11.4±3.5)×109/L、(128±33) U/L、(38 ± 14) μmol/L和(10.6±3.0)×109/L、(135±35) U/L、(44±16) μmol/L,第4天分彆為(7.8±2.9)×109/L、(48±14) U/L、(21 ±8) μmol/L和(6.9±2.1)×109/L、(43±13) U/L、(20±7)μmol/L,兩組比較,差異無統計學意義(t=1.018,-0.872,-1.767,1.553,1.836,1.044,P＞0.05).對照組和加速康複組患者肛門排氣時間、開始進食時間、術後輸液時間、住院時間分彆為(42±13)h、(45±14)h、(6.8±2.3)d、(11.3 ±4.5)d和(35±11)h、(19 ±7)h、(4.2±1.8)d、(9.6 ±2.4)d,兩組比較,差異有統計學意義(t=2.741,10.524,5.485,2.077,P＜0.05).對照組和加速康複組患者住院總費用分彆為(18 729±3 127)元和(16 981 ±2 756)元,兩組比較,差異有統計學意義(t=2.574,P＜0.05).術後1箇月,所有患者肝功能恢複正常,T管膽道造影檢查髮現兩組患者各有4例結石殘留,經膽道鏡取石痊愈;至隨訪結束,所有患者未再次齣現腹痛、黃疸和髮熱等膽道併髮癥.結論 ERAS聯閤LCBDE治療膽總管結石安全,具有併髮癥髮生率低、術後恢複快、住院時間短、總費用少等優點.
목적 탐토가속강복외과(ERAS)연합복강경담총관탐사술(LCBDE)재담총관결석환자치료중적림상료효.방법 선취2011년1월지2013년12월환남의학원부속익기산의원수치적84례담총관결석환자진행전첨성연구.채용수궤、단맹대조법,통과수궤수자표법장입조환자분위대조조화가속강복조.량조균행LCBDE,대조조환자위술기채용전통처리방안;가속강복조환자위술기채용ERAS처리방안.채용문진수방,료해환자술후림상표현、간공능화시부유결석잔류,수방시간절지술후6개월.비교량조환자수술시간、술중출혈량、술후병발증、장공능회복시간、주원시간、주원총비용화수방정황등지표.정태분포적계량자료이x±s표시,량량비교채용독립양본t검험,계수자료비교채용x2검험.결과 사선출부합연구조건적환자75례,대조조35례,가속강복조40례.량조환자수술균순리완성.대조조화가속강복조환자수술시간화술중출혈량분별위(185±46) min、(124±28) mL화(178±37) min、(114±32) mL,량조비교,차이무통계학의의(t=0.729,1.431,P＞0.05).대조조환자분별유12、14、10례발생술후절구동통、구토화각류감염,가속강복조분별유5、6、4례,량조비교,차이유통계학의의(x2=5.054,5.966,4.241,P ＜0.05).대조조화가속강복조환자술후제1천WBC、ALT、DBil분별위(11.4±3.5)×109/L、(128±33) U/L、(38 ± 14) μmol/L화(10.6±3.0)×109/L、(135±35) U/L、(44±16) μmol/L,제4천분별위(7.8±2.9)×109/L、(48±14) U/L、(21 ±8) μmol/L화(6.9±2.1)×109/L、(43±13) U/L、(20±7)μmol/L,량조비교,차이무통계학의의(t=1.018,-0.872,-1.767,1.553,1.836,1.044,P＞0.05).대조조화가속강복조환자항문배기시간、개시진식시간、술후수액시간、주원시간분별위(42±13)h、(45±14)h、(6.8±2.3)d、(11.3 ±4.5)d화(35±11)h、(19 ±7)h、(4.2±1.8)d、(9.6 ±2.4)d,량조비교,차이유통계학의의(t=2.741,10.524,5.485,2.077,P＜0.05).대조조화가속강복조환자주원총비용분별위(18 729±3 127)원화(16 981 ±2 756)원,량조비교,차이유통계학의의(t=2.574,P＜0.05).술후1개월,소유환자간공능회복정상,T관담도조영검사발현량조환자각유4례결석잔류,경담도경취석전유;지수방결속,소유환자미재차출현복통、황달화발열등담도병발증.결론 ERAS연합LCBDE치료담총관결석안전,구유병발증발생솔저、술후회복쾌、주원시간단、총비용소등우점.
Objective To investigate the application value of perioperative enhanced recovery after surgery (ERAS) combined with laparoscopic common bile duct exploration (LCBDE) in the treatment of choledocholithiasis.Methods The clinical data of 84 patients with choledocholithiasis who were admitted to the Yijishan Hospital from January 2011 to December 2013 were prospectively analyzed.A single-blind,randomized,controlled study was performed in the 75 patients who were allocated into the control group and the enhanced recovery after surgery group (ERAS group) based on a random number table.All the patients underwent LCBDE,the patients in the control group received conventional perioperative management and the patients in the ERAS group received perioperative management according to enhanced recovery rehabilitation program.All the patients were followed up by outpatient interview till postoperative month 6.The clinical features,liver function and residual stones in the patients were observed.The operation time,postoperative complications,postoperative intestinal function recovery,duration of hospital stay and hospital expenses in the two groups were compared.Measurement data with normal distribution were presented as x ± s.Comparison between groups were evaluated with an independant sample t test.Count data were analyzed using the chi-square test.Results All the 75 eligible patients undergoing successful operation were randomly divided into the control group (35 patients) and the ERAS group (40 patients).The operation time and volume of intraoperative blood loss in the control group and the ERAS group were (185 ±46)minutes and (124 ±28)mL,(178 ±37) minutes and (114 ±32)mL,respectively,with no significant difference (t =0.729,1.431,P ＞ 0.05).There were 12,14 and 10 patients in the control group and 5,6 and 4 patients in the ERAS group with postoperative incision pain,vomit and infection,showing a significant difference (x2=5.054,5.966,4.241,P ＜ 0.05).The level of white blood cell,alanine aminotrausferase and direct bilirubin in the control group and in the ERAS group were (11.4 ± 3.5) × 109/L,(128 ± 33)U/L,(38 ±14) μmol/L and (10.6 ± 3.0) × 109/L,(135 ± 35) U/L,(44 ± 16) μmol/L at postoperative day 1,compared with (7.8 ±2.9) × 109/L,(48 ± 14) U/L,(21 ± 8) μmol/L and (6.9 ±2.1) × 109/L,(43 ± 13) U/L,(20 ±7) μmol/L in the 2 groups at postoperative day 4,respectively,showing no significant difference between the 2 groups (t =1.018,-0.872,-1.767,1.553,1.836,1.044,P ＞ 0.05).The postoperative first flatus day,time of food intake,time of postoperative infusion and duration of hospital stay were (42 ± 13)hour,(45 ±14) hours,(6.8 ±2.3)days and (11.3 ±4.5)days in the control group,and (35± 11)hours,(19 ±7)hours,(4.2 ± 1.8) days and (9.6 ± 2.4) days in the ERAS group,with a significant difference between the 2 groups (t =2.741,10.524,5.485,2.077,P ＜ 0.05).The total hospital expenses was (18 729 ± 3 127) yuan in the control group,which was significantly greater than (16 981 ±2 756) yuan in the ERAS group (t =2.574,P ＜ 0.05).The liver function of all the patients was recovered at the postoperative month 1.Four patients with residual stones in the 2 groups were detected by T-tube cholangiography,and were cured by removal of gallstones by choledochoscopy.There were no complications of the abdominal pain,jaundice and fever in all the patients till the end of follow-up.Conclusion ERAS combined with LCBDE for the treatment of choledocholithiasis is safe and feasible,with the advantages of low morbidity,quick recovery,short duration of hospital stay and less hospital expenses.
